Cardiovascular Event Rates High in Middle Age: CDC

Nancy A. Melville    

September 11, 2018

As many as one in three hospitalizations and deaths related to cardiovascular events in 2016 involved adults in middle-age — between the ages of 35 and 64 — yet up to 80% of the events were preventable, new findings from the Centers for Disease Control and Prevention (CDC)'s Million Hearts 2022 initiative suggest.

"We are disappointed to see the progress in preventing heart disease and cardiovascular death rates stalling and rates even increasing in some adults, when 80% of heart disease and strokes are preventable," said Anne Schuchat, MD, principal deputy director of the CDC, in a press briefing.

"We have the evidence of what works, and now is the time for healthcare professionals to do more, for healthcare facilities and partners to do more, for states and for all of us to do more."

The study, published as part of the CDC's monthly Vital Signs report, provides baseline data on the burden in 2016 for the Million Hearts 2022 initiative, a collaboration of the CDC and Centers for Medicare & Medicaid Services whose goal is preventing 1 million cardiovascular events between 2017 and 2022.

Overall, there were 2.2 million hospitalizations nationwide for cardiovascular events in 2016, resulting in $32.7 billion in costs and 415,480 deaths.

Data from sources including Healthcare Cost and Utilization Project databases and the National Vital Statistics System show that as many as 805,000 of the 2016 hospitalizations and 75,245 deaths occurred among adults under age 65 years.

"Many of these cardiovascular events are happening to middle-aged adults — who we wouldn't normally consider to be at risk," Schuchat said. "Most of these events can be prevented through daily actions to help lower risk and better manage medical conditions."

The highest morality rates were seen among non-Hispanic blacks (211.6 per 100,000), and men had the highest hospitalization rates (989.6 per 100,000), with mortality rates of 172.3 per 100,000, and the rates increased with age.

The study also provides state-level data on nonfatal cardiovascular events — and showed surprisingly substantial variations in numerous measures: Rates of emergency department visits for cardiovascular events in 2016, for instance, per 100,000, ranged from 56.4 in Connecticut to as high as 274.8 in Kentucky; hospitalizations, per 100,000, ranged from 484.0 in Wyoming to 1670.3 in Washington, DC; and mortality, per 100,000, ranged from 11.2 in Vermont to 267.3 in Mississippi.

"This is one of the first studies to demonstrate striking state-level variation in nonfatal cardiovascular event rates and hospitaliza­tion costs using data collected among adults of all ages and across all payer types, including the uninsured," the authors said.

While known geographic differences in disease prevalence and severity partially explain the variations, other key factors include differences in care delivery and the quality of public health services, the authors noted.

Collectively, the figures represent unacceptable rates of preventable disease and death, said Janet Wright, MD, a board-certified cardiologist and executive director of Million Hearts.

"Across all age groups and races, we found that each day in 2016, 1000 Americans lost their lives and more than 6000 people were admitted to the hospital with events that Million Hearts is trying to prevent," she said in the press briefing.

"These staggering numbers arise from many small opportunities missed each day to find and treat the common and controllable causes of CV disease."

Wright noted the report's findings on some key reasons for the high rates of deaths and hospitalizations, including that the following:

  • 9 million American adults are not yet taking aspirin as recommended;
     

  • 40 million adults with high blood pressure are not yet under safe control;
     

  • 39 million adults can benefit from managing their cholesterol;
     

  • 54 million adults are smokers, most of whom want to quit; and
     

  • 71 million adults are not physically active.

Based on the report's findings, the authors estimate that, in the absence of effective prevention efforts, approximately 16.3 million cardiovascular events and $173.7 billion in hospitalization costs could occur between 2017 and 2022.

To achieve the Million Hearts' goal of collectively preventing 1 million events from 2017 through 2021, each state would need to reduce its cardiovascular event totals by approximately 6% during the period.

Strategies recommended to help clinicians work toward achieving that goal include focusing on the "ABCS" of cardiovascular care: aspirin when appro­priate, blood pressure control, cholesterol management, and smoking cessation.

Patients should also be advised to reduce sodium consumption and tobacco use and increase physical activity.

Prevention strategies are further outlined on the Million Hearts 2022 website.

"Preventing 1 million heart attacks, strokes, and other cardiovascular events by 2022 is an ambitious goal, but lives of our loved ones are in balance, and it's a goal we really need to achieve," Schuchat said.

In further commenting on the report, Vincent Bufalino, MD, a cardiologist and head of Advocate Medical Group, Chicago, Illinois, noted that the decades-long reductions in cardiovascular disease that corresponded with steep declines in smoking may have resulted in a false sense of security.

"It's been incredible to see that age-related mortalities have probably dropped by as much as a half over the course of my career, but that decline is clearly flattening out, and this should be a wake-up call that we haven't conquered this — there's still a lot of work to do," he told theheart.org | Medscape Cardiology.

Substantial improvements in outcomes after cardiovascular events have also eased concerns, he noted.

"There's an impression that 'Oh, it's heart disease — they can just put a stent in and fix it,' but if this was something like lung cancer, I'm not sure it would be taken as lightly," Bufalino said.

A key challenge in continuing to tackle the disease is addressing the combination of factors that may increase the cardiovascular risk in certain populations, he noted.

"We're especially concerned about the increased risk in populations such as African-Americans and Hispanics, and the factors that may play key roles range from access limitations to issues with compliance with therapy," he said.

"And part of it is simply that we're just not really doing a good job of controlling cholesterol and blood pressure in this country."

The speakers and Bufalino have disclosed no relevant financial relationships.

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